| Objective: The phenomenon is called no-reflow or slow-flow,which after primary percutaneous coronary intervention(PPCI)therapy in some patients with acute ST elevation myocardial infarction(STEMI)the criminal coronary restores patency but the blood flow does not restore to thr-ombolysis in myocardial infarction trial(TIMI)flow grade 3.No-reflow or slow-flow suggests that the coronary microvascular is damaged.The myocardial tissues in the patients with no-reflow or slow-flow can not be perfused effectively.The clinical outcomes in the patients with no-r-eflow or slow-flow are very poor.This paper holds that the microthro-mbus embolism and microthrombosis-in-situ in the patients with STEMI undergoing PPCI therapy block coronary microvascular and lead to poor myocardial perfusion.Therefore,this study was conducted to eval-uate the effects of the treatment used as the supplement of the PPCI that we infused recombinant human prourokinase(rh Pro-UK)(10mg,which dissolved in 10 ml of normal saline)in proximal area of the criminal endovascular before and after stent implantation on myocardial perfusio-n in the patients with STEMI.Methods: 60 patients met the inclusion criteria and exclusive criteria were included in the trial in the First Ho-spital Affiliated to Hebei Medical University from January 2018 to Se-ptember 2019.They were randomly allocated into control group(n=30)and Intervention group(n=30).We infused rh Pro-UK(10mg,which disso-lved in 10 ml of normal saline)in proximal area of the criminal endovascular in the intervention group before and after stent implantation.The patients in the control group underwent PPCI therapy.The differences in the incidence of postoperative TIMI flow grade 3,TIMI myocar-dial perfusion(TMP)grade 3,ST-segment elevation resolution in 2 ho-urs,bleeding events in 1 week,major adverse cardiac events in 1 mon-th,and major adverse cardiac events in 3 months between intervention group and the control group were compared.The differences in the mea-n of postoperative corrected TIMI frame count and left ventricular eje-ction fraction(LVEF)at the end of 3rd month between the two groups were compared.Results: There was no difference in the baseline information between the two groups(P>0.1).The incidence of postoperative TIMI flow grade 3 was significantly different between two groups(P<0.05).95% confidence interval(CI)of rate ratio(RR)was(1.005,1.612).The incidence of postoperative TMP grade 3 was significantly different between two groups(P<0.05).95%CI of RR was(1.007,1.859).The mean of postoperative corrected TIMI frame count was significantly dif-ferent between two groups(P<0.05).95%CI of mean difference was(-2.586,-0.663).There was no difference in the incidence of postopera-tive ST-segment elevation resolution in 2 hours(76.70% vs 73.30%)between the two groups(P>0.05).There was no hemorrhea(such as cere-bral hemorrhage and gastrointestinal hemorrhea)in the two groups(P>0.05).However,there was no difference in the postoperative mild hemo-rrhage(such as gingival bleeding and ecchymoma)in 1 week(4 vs 2)between the two groups(P>0.05).The mean of postoperative LVEF at the end of 3rd month was significantly different between two group-s(P<0.05).95%CI of mean difference was(1.033%,5.301%).There was no difference in the incidence of postoperative major adverse cardi-ac events in 1 month(26.70% vs 30.00%)between the two groups(P>0.05).There was no difference in the incidence of postoperative major a-dverse cardiac events in 3 months(23.30% vs 20.00%)between the tw-o groups(P>0.05).No one patient died in 3 months.CONCLUSION: The treatment used as the supplement of the PPCI that we infused rec-ombinant human prourokinase(rh Pro-UK)(10mg,which dissolved in 10 ml of normal saline)in proximal area of the criminal endovascular bef-ore and after stent implantation on myocardial perfusion in the patient-s with STEMI,could improve myocardial perfusion and LVEF at the end of 3rd month.The postoperative hemorrhea risk of the treatment in1 week could not be evaluated.However,the treatment might not inc-rease the risk of mild hemorrhage.The treatment could not improve a-dverse clinical outcome in 1 month 3 months.The postoperative death risk of the treatment could not be evaluated. |
PDF Full Text Request